Medknow Publications on behalf of Indian Association of Medical Microbiology
Abstract
We report a case of gastrointestinal histoplasmosis in a 45-year-old
HIV positive man who was misdiagnosed as a case of colonic cancer. The
patient presented with low-grade fever, pain in lower abdomen, anorexia
and weight loss of six months duration. On examination a lump in the
left iliac fossa was detected. Colonoscopy revealed stricture and
ulcerated growth in the sigmoid colon. Radiological investigations
suggested malignant/inflammatory mass in the sigmoid colon with luminal
compromise. Patient was operated and ulcerated tissue was sent for
histopathological examination, which revealed numerous intracellular,
2-4 μm, oval, narrow-based budding yeast cells suggestive of
Histoplasma capsulatum . Subsequently, the patient developed fluffy
opacities on X-ray chest. Examination of sputum revealed presence of
acid-fast bacilli and yeast forms of H. capsulatum . Patient was
started on amphotericin B but died on the seventeenth postoperative
day. The diagnosis of histoplasmosis was made retrospectively. Atypical
presentation and rarity of the disease led to this diagnostic pitfall.
To the best of our knowledge this is the first report of
gastrointestinal histoplasmosis presenting as colonic pseudotumour from
India